Report of 31 Aug '09

Hello from Indiana -

My neighbor has Persian music playing, and it is haunting and soul-stirring. Where would we be without music? Probably savage beasts.

A giant triumph occurred this week. I have mentioned often about patients asking for unwarranted items like narcotic pain meds and Disability paperwork. A couple of weeks ago, I had a patient, Ms. X, who had apparently been successful in getting excuses for work absenteeism (longer than her illness) from elsewhere. She told me during our appointment that she had missed work the previous day due to a therapist's appointment, and wanted a note from me to that effect; I stated that I could give her a note about my appointment, but certainly not the therapist's and suggested she ask the therapist. I finished my examination, and then the patient started crying, speaking of numerous emotional stressors; the astute front office staff had warned me beforehand of this modus operandi, and I held the patient's arm, told her she could take her time to compose herself and left the room. She later got the note she wanted from another doctor and the nurse who "runs" me (rooms my patients and assists me in other ways) told me several days later that Ms. X had come to our office to make an appointment, stated that she was there to see my colleague (whose name she apparently stressed), and said, "And no, I will not see Dr. Weiss." Quel joy, quel achievement. I slept well that night. It's the types that want to wear you down into giving what they want that are the bigger challenge, but there is much joy in handling - in any fashion, other than succumbing to - the demands of such patients as Ms. X.

Some fine interactions last week - ran into Kurt Broderick at St. V. He's a pharmacist, a wonderful sort and someone who has always been interested in my work, annually making hefty donations in cash or kind (crayons and markers when we tutored). It was great to run into Kurt and we talked a fair amount. I spent a Saturday evening at the home of a new friend, Cindy Belloli, with several of her friends playing euchre and it was a fun, fun time. I took a tap class with a different instructor and enjoyed it. Most of the weekend was spent with in-laws and, as always, it was filled with merriment, fun, laughter and copious food including some delicious watermelon. I have been struggling with a relative wildly strewing the seeds of disharmony in our family, which is very novel to me and something I do not relish: I have seen those with little family support, and have always felt grateful that both Scott and I have robustly good family. Talking of this relative and the antics was therapeutic, and Scott's mother and aunt had a lot of sage insight and perspective, as well as a hefty dose of humor.

Saturday night was spent at the home of Kris and Gabe, seeing movies ad infinitum ("Burn after Reading," "He's just not that into you," "Blade Runner"). It was lovely. I saw "Shrink" yesterday, and being a big Kevin Spacey fan, liked it a lot. And then, the coup-de-grace: we went to a Moody Blues concert. The last time they had played in "my" city (Philadelphia), tickets were sold out and I was sorry. This time, tix were plentifully available and affordable ($35); Colleen, Sonja, Carolyn and I went. (When Naren heard that, he said, "Fun!" Navin said, "Moody Blues?") Anyhoo, the concert was fabulous and there's something so nice about hearing live music, especially when it's familiar. The weather was crisp and cool, I had an outdoor blanket lent by Kris, there were good friends and nice people and apples and chocolate-covered almonds around, the music was fabulous, and all in all, it was an evening to remember.

As I told the Weiss men, I am ready to head home. Time to get to smiling, happy, grateful people and those who would smile in the midst of grinding poverty, those who do not know what they do not have.

Unw -

R

Report of 22 Aug '09

Hello from the library -

It's so nice that such a place exists. All the books, magazines, Internet - free.

Things have got busier in the patient-seeing department, and I appreciate that. We had a lady in, complaining of leg pain. She works 7 days a week, waitressing, and has raised 2 kids (almost single-handedly) whom she is proud of. Her dream has been to own a house and she is about to. The leg pain is disabling and I aim to get to the root of it, thus have ordered an MRI. Almost everyone on this blog list knows of my aversion to narcotic pain meds, but I prescribed them this time as it seemed like this lady needed them. This patient smokes a lot; I mentioned my (perceived) colossal accommodation of the narcotics and said that she must, in return, stop smoking. She said she'd give it an honest effort. She then asked if I was a temporary doc, and I smiled and said yes; she was irate, asking why their docs were temporary. I told her what I do the rest of the year and she simmered down. I want to find the cause of her pain before I head off; let's see if the plan comes to fruition.

I saw "The Time Traveler's Wife," having finished the book, and enjoyed both the book and the movie. I did not know until 2 days ago that Eric Bana is Australian. I am impressed with these Aussie types that get to Hollywood and fall quite easily into the American accent: Russell Crowe, Guy Pierce, Nicole Kidman, Hugh Jackman, and now Eric Bana. I think the American accent is difficult to adopt without sounding ridiculous or having lived here for years or getting sound practice like the actors, and I commend these folks. I also saw "The Goods;" had the poster been visibly displayed, announcing it to be a Will Ferrell movie, I would not have gone. Ving Rhames is the name that drew me. It was, as the review said, "a vulgar comedy." Today, I saw "Inglorious Basterds." It was excellent - my respect for Mr. Pitt has increased after seeing his comedic talents. Like Marilyn Monroe, his are extraordinarily good. Quentin Tarantino is a fan of blood and gore, and there is plenty of that; there is also a heap of excellent acting and the cinematography is breathtaking.

I have moved out of the warm, loving home of Kris Rea and Gabe Soukup to the warm and loving home of MaryBeth and Andrew Simon. The Simons are good folks, and their daughters, Miranda and Morgan, like the Soukup girls, also go out of the way to make me feel at home. We are truly privileged in our friends.

Some fine interactions last week: I was at a party at the Rea-Soukup residence and got to see Carolyn Scanlan, Will Craighead and new friends Traci and Sid Norton, and Joe Macko. It was a fun evening. Olivia Fondoble sent me a giant package of clothes and goodies, and I enjoyed diving into it. Eve Swiacki and her sister, Denise, also sent packages and those were lovely, too. I am almost completely outfitted in Olivia Fondoble today, as I am sometimes outfitted in Carol Dixon, or Eve Swiacki, or Denise Carroll. It is nice to get hand-me-ups or -downs.

I phoned home and talked to the men. Chaos reigns there. Sigh. A big dream is for the chaos to subside before I get there; Naren and Navin know the wrath of Khan (me) and will do much in their power to ensure there is a small honeymoon period after my return, before the chaos overflows. Upbringing counts for much in how a young man/woman will run a household, doesn't it, and I hope that one day these 2 are the sorts of husbands their wives will cherish. (Both boys' educational institutions were closed due to swine flu, and both were enjoying the time off.)

Unw -

R

Report of 9 Aug '09

Hello from the libraire -

Hot outside, finally. July was so cool - ostensibly the coldest on record - that I had to lug out all the long-sleeved shirts I possess. And go for my workout in sweatpants, prompting at least one fellow spinner (cyclist) to ask how I could wear those. I told him that compared to 104 deg heat, what I'd left in India, I was freezing.

I changed locations and am working in methamphetamine country now. One of the clinics has 2 nurse practitioners (NP's), both of whom are competent. One of them had asked me to see a young patient with chest pain. No worries, we aim to please. This young woman had been hospitalised, worked up by a cardiologist and nothing abnormal was found; she was then in my exam room, and about 2 sentences in, stated she wanted Percocet (a narcotic pain medicine). I told her clearly that I would not refill the medicine, and continued taking her history; when I asked how I could help her, she stated again that she wanted a refill on the Percocet. Now, I had not spoken earlier in Tamil, or Coorgi, or Hindi, or Latin; I had spoken in English - accented, surely, but English. There was not a way for her to misunderstand, "I will not refill the Percocet." She then said she was going to call her mother, who worked at the hospital and was known to my colleagues, and I told her to go ahead, and left the room. I was furious: exactly why was I working her up, when the regular providers had seen her time and again? The NP's then clarified that they were puzzled by the chest pain, and I told them my finding, that it was likely due to the patient's wanting Percocet. Such patients used to say "Back pain," now they say the much more worrisome "Chest pain." I am not a nice person when I am angry, and when the nurse came back to me and said the patient was crying, that she had had a bout of chest pain right then, I told the nurse she could take an EKG by all means, but that there was no way this person was getting Percocet from me.

My father once asked why I was not content to work a while in these areas, wasn't the money great compared to what I make in India (about $0); I stated that patient interactions frequently deteriorated to this kind of drivel, and that, really, after about 3 months of this, I was ready to return to smiles and happiness and good humor *among the desperately, desperately poor* in India. The sad thing is, types like this patient deprive genuine cases from getting the pain meds they need.

There was another patient who came in with her husband, and both were delightful. The lady had noticed a change in her bowel patterns, and as I took a detailed history, the husband provided a fair amount of collateral; the love and affection between them was evident, which was lovely. He is an alumnus of Purdue Engineering, and has invented (she told me) a new, inexpensive building technique. He was kind enough to share the information with me, and I am looking forward to sharing it with other NGO's when I get home. This couple was extraordinarily good company, and all of us lingered a bit over the visit.

My father was at a plastic surgery conference in Mahabalipuram near Chennai, and on the last day (today), Scott had picked him up from the venue and taken him home, to spend some time before taking the train to Madurai. Several aunts and 1 cousin had gone from Coorg to keep my mother company during this time, and she sounded cheerful when I talked to her. I then called Chennai, and my family was well. Again, nice that Scott gets along with the in-laws enough to host them even when I am not around. Naren and Navin are also well, and keeping up (with mostly good grace) in school and college. We had had a long email discussion about the sensible choices they'd made, and I'd cherished it.

As the men had seen "The Hangover" with Anu's family last weekend and had raved about it, I saw it this weekend. It was funny enough, and I laughed out loud several times during it. Some of the humor was ribald and raunchy, which I don't care for, but many parts of the flick were just bloody good fun. And today, I saw "Julie and Julia." It was dreadful. Meryl Streep and Stanley Tucci were outstanding, of course, but they could not save the film. Some of the best food-based films - "Chocolat," "Tampopo" - have succeeded because the characters' art of making and eating the food are done with finesse. Here, the young pair (whatever their names are) smacked their way through delectable cuisine, ruining it, shredding my appetite, and then had singularly poor dialogue to carry off.

Unw -

R

Report of 3 Aug '09

Hello from Indiana -

I was at the lib yesterday, but did not get a chance to blog as I wanted to read the paper. I don't get my news online, thus had no clue Prince William was engaged - when did this happen? Must have been in the last 6 weeks, the time that I have not read the paper.

Work is going well, and I am not as staggeringly homesick as I was a couple of times in the first weeks that I was here. Last week, I changed locations and now go to Elwood and Alexandria, methamphetamine country. I had an 18 yo patient last week in Elwood who told me that he was addicted to oxycodone, a narcotic painkiller, and needed help coming off it. His father, truly not very old, maybe 40's, had had a stroke and was on disability, and the family was looking for affordable rehab. St. Vincent, my current employer, is all about giving good care at affordable rates, including for the indigent, and we rooted out some resources. I think the young man might still be keeping some details from me, but I admired his candor, said so, told him that admitting the problem was the first step to overcoming it and we chatted. In a Tamil movie some time ago, 1 person told another that there were only 2 people in the whole world who'd wish him well continuously: his parents. So I told this kid that, suggested he stay away from his sources, hook up with a young lady if any (and there was), appreciate his parents' solid support, and return to me for a follow-up. As I concluded the visit, I noticed that the father was in tears and I told them they could take their time in the exam room before coming out.

I'll kiss my sons double when I go home. It is getting more difficult to resist peer pressure in this age of Internet, weird TV, movies, drugs, sex and rock-n-roll, and I emailed my sons and told them I admired their diligence in the choices they have made.

Some fine times last week - I rounded with Dr. Love and that was nice, good to get solid teaching from a fine clinician. Then I headed off to my in-laws' place. Scott's mother, Jan; her sister Anita and brother-in-law Norb, have adjoining farms and they are beautiful places. These folks are among my most favorite people. Anita and Norb took us out to eat, and Saturday was spent reading and catching up on chatter - a very relaxed, fun time full of bonhomie and much eating.

Yesterday, I met Louise Hass for dinner. Louise retired as librarian of St. V, and is a remarkable person with a core of steel and plenty of beauty. She has sustained a loss (her son), as have I (my brother), and we spend a fair amount of time talking about this. The bond that bereaved folks share is unusual, and extraordinary, and I have found much solace in unloading to Louise. We also talked of a zillion other things, laughing a fair amount. Louise treated me to dinner at my favorite restaurant, Bravo, and the good food, the perfect weather outside, and the lovely company made for a memorable evening. She had a couple of giant chocolate bars for the 3 Weiss men, so she likes to spoil by proxy too.

I saw "(500) Days of Summer," which was good. Yesterday, I saw "The Hurt Locker" and that was magnificent. It's about an American bomb squad in Iraq and was "visceral" (from a review) and cerebral. Kathryn Bigelow, the director, has managed to extract convincing performances from her entire cast, and the movie played like a documentary. The best part is the relatively unknown cast (Jeremy Renner, Anthony Mackie, more unknowns) and the fact that big names (Guy Pearce, Ralph Fiennes, David Morse) played bit roles. It is not a movie for everyone; many times during the flick, I thought, "Goodness, whose war are they fighting?"

My sister, Anu, turned 50 over the weekend, and she and her family spent part of it with the 3 Weiss men. There was much laughter and camaraderie when I phoned, and the weekend was ostensibly spent eating, seeing a movie and eating some more. I am glad Anu had a good b'day, chose to see my family during it, and that all of us have a good relationship with each other. I can't think where I'd be if we did not have our families.

Unw -

R